Provider Demographics
NPI:1831127190
Name:WALBRIDGE, DON JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:JAY
Last Name:WALBRIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:JAY
Other - Last Name:WALBRIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:125 S KALAMAZOO MALL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4832
Mailing Address - Country:US
Mailing Address - Phone:269-343-3900
Mailing Address - Fax:269-343-5640
Practice Address - Street 1:125 S KALAMAZOO MALL
Practice Address - Street 2:SUITE 204
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4832
Practice Address - Country:US
Practice Address - Phone:269-343-3900
Practice Address - Fax:269-343-5640
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009004207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11/2698492Medicaid
MI11/2754180Medicaid
MI11/4687068Medicaid
MI11/4687068Medicaid
MI11/2698492Medicaid
MIE49455Medicare UPIN
MI11/2754180Medicaid